Thorac Cardiovasc Surg 2000; 48(6): 360-363
DOI: 10.1055/s-2000-8351
Original Cardiovascular
Original Paper
© Georg Thieme Verlag Stuttgart · New York

High-Intensity Transient Signals (HITS) as a Parameter for Optimum Orientation of Mechanical Aortic Valves[*]

P. Kleine1 , M. Perthel1 , J. M. Hasenkam2 , H. Nygaard2 , S. B. Hansen2 , J. Laas1
  • 1Herz-Kreislauf-Klinik Bevensen, Department of Cardiothoracic Surgery, Bad Bevensen, Germany
  • 2University Hospital Skejby Sygehus, Department of Cardiovascular Research, Aarhus, Denmark
Further Information

Publication History

Publication Date:
31 December 2000 (online)

Background: In previous studies [1] [2], the impact of valve orientation on the hemodynamic performance of mechanical aortic valves has been demonstrated. This study investigates Turbulence (RNS values) and High Intensity Transient Signals (HITS) as a new and objective parameter for hemodynamics in different orientations of Medtronic Hall (MH) and St. Jude Medical (SJM) aortic valves. Methods: A rotation device carrying MH or SJM valves was implanted in 4 pigs. The device allowed valve rotation without reopening the aorta. In different orientations, turbulent shear stresses (RNS values) and HITS were measured. Results: RNS and HITS changed for both valve designs in various orientations, with superior results for the MH in the hemodynamically best orientation. Downstream turbulence (RNS) and HITS varied into the same direction, but a one-to-one correlation was not observed. Conclusions: RNS and HITS vary with respect to valve orientation and design with superior results for the tilting disc valve. Both MH and SJM valves showed lower turbulence and HITS counts in their hemodynamically best orientations. HITS were related to downstream turbulence and the hemodynamic performance of the mechanical aortic valves.

1 Presented at the 3rd Joint Meeting of the German, the Austrian and Swiss Societies for Thoracic and Cardiovascular Surgery, Lucerne, February 9 - 12, 2000

References

  • 1 Kleine P, Perthel M, Nygaard H, Hansen S B, Paulsen P K, Riis C, Laas J. Medtronic Hall versus St. Jude Medical Mechanical Aortic Valve: Downstream Turbulences with Respect to Rotation in Pigs.  J Heart Valve Dis. 1998;  7 548-555
  • 2 Laas J, Kleine P, Hasenkam J M, Nygaard H. Orientation of Tilting Disc and Bileaflet Aortic Valve Substitutes for optimum Hemodynamics.  Ann Thorac Surg. 1999;  68 1069
  • 3 Grosset D G, Cowburn P, Georgiadis D, Darrgie H J, Faichney A, Lees K R. Ultrsound detection of cerebral emboli in patients with prosthetic heart valves.  J Heart Valve Dis. 1994;  3 128-132
  • 4 Deklunder G, Lecroart J L, Savoye C, Coquet B, Houdas Y. Transcranial high intensity Doppler signals in patients with mechanical heart valve prosthesis: their relation with abnormal intracavitary echoes.  J Heart Valve Dis. 1996;  6 662-667
  • 5 Rams J A, Davis D A, Lolley D M, Berger M P. Detection of circulating cerebral emboli using transcranial Doppler ultrasound in a sheep model.  J Heart Valve Dis. 1993;  3 27-41
  • 6 Mackay T G, Georgiadis D, Grosset D G, Lees K R, Wheatley D J. On the origin of cerebrovascular microemboli associated with prosthetic heart valves.  Neurosci Res. 1995;  17 349-352
  • 7 Raco L, Belcher P R, Sim I, McGarrity A, Bernaca G M, Wheatley D J. Platelet aggregation and High-Intensity Transient Signals (HITS) in a sheep model of mitral valve replacement.  J Heart Valve Dis. 1999;  8 476-481
  • 8 Milano A, D'Alfonso A, Codecasa R. et al . Prospective evaluation of frequency and nature of Transcranial High-Intensity Doppler Signals in prosthetic valve reecipients.  J Heart Valve Dis. 1999;  8 488-494
  • 9 Markus H S, Brown M M. Differentiation between different pathological cerebral embolic material using transcranial Doppler sonography.  Stroke. 1993;  24 1-5
  • 10 Caplan L R. Silent brain infarcts. Cerebrovasc Dis 1994 (Suppl. 1: 29-32
  • 11 Stump D A, Tegeler C H, Rogers A T. Neuropsychological deficits are associated with the number of emboli detected during cardiac surgery.  Stroke. 1993;  24 3A
  • 12 Deklunder G, Prat A, Lecroart J L, Roussel M, Dauzat M. Can cerebrovascular microemboli induce cognitive impairment in patients with prosthetic heart valves?.  Europ J Ultrasound. 1998;  7 47-51
  • 13 Khan S S. Pitfalls in the interpretation of Doppler gradients in prosthetic valves.  Clin Cardiol. 1992;  18 22-28
  • 14 Markus R H, Heinrich R S, Bednarz J. et al . Assessment of small-diameter aortic mechanical prostheses - physiological rlevance of the Doppler gradient, utility of flow augmentation, and limitations of orifice area estimation.  Circulation. 1998;  98 866-872
  • 15 Schuchmann H, Feigenbaum H, Dillon J C, Chang S. Intracavitary echoes in patients with prosthetic valves.  J Clin Ultrasound. 1975;  3 107-110
  • 16 Gencbay M, Turan F, Yaymaci B, Degertekin M, Basaran Y, Dindar I, Izgi A. Prevelance of microbubbles associated with mechanical cardiac valves: a prospective transesophageal echocardiographic study.  J Heart Valve Dis. 1998;  7 340-344
  • 17 Georgiadis D, Kaps M, Berg J. et al . Transcranial Doppler detection of microemboli in prosthetic heart valve patients: dependency upon valve type.  Eur J Cardio-thorac Surg. 1996;  10 253-258
  • 18 Sliwka U, Georgiadis D. Clinical correlations of Doppler microembolic signals in patients with prosthetic cardiac valves - analysis of 580 cases.  Stroke. 1998;  28 140-143
  • 19 Gencbay M, Turan F, Yaymaci B, Degertekin M, Basaran Y, Dindar I, Izgi A. Prevelance of microbubbles associated with mechanical cardiac valves: a prospective transesophageal echocardiographic study.  J Heart Valve Dis. 1998;  7 340-344
  • 20 Kleine P, Perthel M, Hasenkam J M, Nygaard H, Hansen S B, Laas J. Downstream turbulence and High Intensity Transient Signals (HITS) following Aortic Valve Replacement with Medtronic Hall and St. Jude Medical Valve Substitutes.  Eur J Cardiothorac Surg. 2000;  00 1-4

1 Presented at the 3rd Joint Meeting of the German, the Austrian and Swiss Societies for Thoracic and Cardiovascular Surgery, Lucerne, February 9 - 12, 2000

Prof. Dr. J. Laas

Department of Cardiothoracic Surgery Herz-Kreislauf-Klinik Bevensen

Römstedter Straße 25

29549 Bad Bevensen

Germany

Phone: 49-5821-821702

Fax: 49-5821-821777

Email: Prof.Laas@t-online.de

    >